Awareness and use of medication management services in relation to medication adherence prior to hospitalisation among older adults in Regional Australia

International Journal of Clinical Pharmacy - Background Ageing is associated with changes in physiology, functional ability, declined in cognition and multiple co-morbidities. Alterations in...     

Implementation fidelity of an intervention programme to enhance adherence to antihypertensive medication in Dutch community pharmacies

International Journal of Clinical Pharmacy - Background Insight into the delivery of interventions is necessary to gain a better understanding of what caused an intervention to succeed or fail. The...     

Opportunities and responsibilities for pharmacists to improve their effectiveness in addressing medication adherence through culturally sensitive collaborations with community health workers

ObjectivesDespite progress in addressing health disparities among vulnerable populations, minority populations are at risk for chronic health conditions associated with multiple determinants of health, which affects their health status and access to care. We offer a potential solution, which creates an unconventional medical team between a pharmacist and a community health worker (CHW). We explore weaknesses and challenges in our medication use system in the context of adherence as a drug therapy problem, the role of culture in shaping medication use, and finally offer a unique paradigm for a collaborative interprofessional team consisting of CHWs and pharmacists.SummaryMedication adherence is far from optimal, especially in minority ethnic populations. Members of an ethnic group may acquire beliefs about illness consistent with their culture’s shared customs. These findings intimate that ethnocultural minority groups may have their own remedies for illness that shape their decision to use medications as prescribed. An interprofessional team in which CHWs and pharmacists collaborate offers an opportunity to improve the effectiveness of pharmacists to address adherence-related problems, especially among minority populations in which culturally determined beliefs can shape medication use decisions.This approach holds promise because CHWs are usually embedded within the community in which their patients live, having experienced the same life experiences. These shared experiences may lead CHWs to uncover medication use practices that pharmacists are not able to discover on their own because the relationship with their patients is often not authentic, which, for many minority patients, can only be established through shared experiences.ConclusionThis paper argues that creating teams of CHWs and pharmacists will help address challenges in achieving health equity and health disparities among vulnerable populations in the medication use system.     

Factors associated with comprehensive medication review completion rates: A national survey of community pharmacists

BackgroundCompletion rates for medication therapy management (MTM) services have been lower than desired and the Centers for Medicare and Medicaid Services has added MTM comprehensive medication review (CMR) completion rates as a Part D plan star measure. Over half of plans utilize community pharmacists via contracts with MTM vendors.ObjectivesThe primary objective of this survey study was to identify factors associated with the CMR completion rates of community pharmacies contracted with a national MTM vendor.MethodslRepresentatives from 27,560 pharmacy locations contracted with a national MTM vendor were surveyed. The dependent variable of interest was the pharmacies' CMR completion rate. Independent variables included the pharmacy's progressiveness stratum and number of CMRs assigned by the MTM vendor during the time period, as well as self-reported data to characterize MTM facilitators, barriers, delivery strategies, staffing, selected items from a modified Assessment of Chronic Illness Care, and pharmacist/pharmacy demographics. Univariate negative binomial models were fit for each independent variable, and variables significant at p < 0.05 were entered into a multivariable model.ResultsRepresentatives from 3836 (13.9%) pharmacy locations responded; of these, 90.9% (n = 3486) responses were useable. The median CMR completion rate was 0.42. Variables remaining significant at p < 0.05 in the multivariable model included: progressiveness strata; pharmacy type; scores on the facilitators scale; responses to two potential barriers items; scores on the patient/caregiver delivery strategies sub-scale; providing MTM at multiple locations; reporting that the MTM vendor sending the survey link is the primary MTM vendor for which the respondent provides MTM; and the number of hours per week that the pharmacy is open.ConclusionsFactors at the respondent (e.g., responses to facilitators scale) and pharmacy (e.g., pharmacy type) levels were associated with CMR completion rates. These findings could be used by MTM stakeholders to improve CMR completion rates.     

Pharmacy-led interventions to improve medication adherence among adults with diabetes: A systematic review and meta-analysis

BackgroundControl of blood glucose and a reduced risk of complications are important treatment goals in diabetes. Medication non-adherence can influence the outcome of diabetes. Involvement of a pharmacist in diabetes care might help patients to achieve better treatment outcomes. Existing literature reviews have focused on a limited number of interventions and outcome measures, and have involved different healthcare professionals. None of the previous reviews have used a standardized effect size to compare the effects of different pharmacist-led interventions and different outcome measures.ObjectiveTo review pharmacist-led interventions to improve medication adherence in patients with diabetes and to assess the effectiveness of these interventions on medication adherence.MethodsSix databases were systematically searched between March and September 2017 for randomized controlled trials: PubMed, Cochrane library, EMBASE, CINAHL, JSTOR, and Web of Science. The outcome measures used were: medication adherence, HbA1c, fasting plasma glucose (FPG), post-prandial blood glucose (PPG), or random blood glucose (RBG). Cohen's d, a standardized effect size, enabled a comparison of studies with different outcome measures. The Cochrane risk of bias tool was used to assess the quality of the studies.ResultsFifty-nine studies were included in this review. Pharmacist-led interventions enhanced outcomes in patients with diabetes (standardized mean difference (SMD) ?0.68; 95% CI -0.79, ?0.58; p < 0.001). Sub-group analysis by intervention strategy, the type of intervention and outcome measures produced similar results. Further analysis showed that education, printed/digital material, training/group discussion, were more effective than other interventions.ConclusionThis finding supports the role of the pharmacist in diabetes care to enhance medication adherence.     

Perspectives of community pharmacists on conscientious objection to provide pharmacy services: A theory informed qualitative study

BackgroundIn recent years, pharmacists have been opting out of certain pharmacy services, particularly, providing contraceptives, for moral reasons. No research has been conducted on the perceptions of community pharmacists toward conscience objection in a secular state with a mostly Muslim population.ObjectiveThis study aimed to provide an in-depth understanding of the factors related to the beliefs of community pharmacists on conscientious objection to provide pharmacy services contrary to their personal beliefs based on the theory of planned behavior.MethodsSemistructured interviews were conducted with a purposive sampling of community pharmacists. A hybrid deductive and inductive qualitative analysis approach was used on the data that were recorded and transcribed verbatim. Constructs related to attitude, subjective norm, and perceived behavioral control were explored.ResultsIn total, 25 community pharmacists were interviewed. Factors affecting pharmacists’ decision to provide pharmacy services when their personal beliefs included the desire to maintain moral integrity, beliefs about consequences for health care service, profit, patient pressure, precedence of professional values, and care for religious sources.ConclusionMost of the community pharmacists were against the behavior of conscientiously objecting to provide pharmacy services in Turkey because of possible negative consequences on health care. The pharmacists who were willing to act based on their personal beliefs were expecting from various third parties to fulfill certain responsibilities to facilitate to adopt the behavior. This novel study highlights the urgent need for more research and training for community pharmacists serving patients in different socioeconomic contexts in both developed and developing countries.     

Identifying over-the-counter information to prioritize for the purpose of reducing adverse drug reactions in older adults: A national survey of pharmacists

BackgroundOver-the-counter (OTC) medication use is associated with risks of adverse drug reactions (ADRs), particularly among older adults. The Drug Facts Label (DFL) is supposed to provide consumers with information that would avoid ADRs, yet research suggests that consumers frequently fail to interact with this critical information. We postulate that emphasizing critical information by placing it on the front of the package may increase its usage. Before doing so, the most critical information from the DFL needs to be identified.ObjectivesThis study aimed to determine which information from the DFL is most critical in reducing ADRs at the time of purchase or use by older adults.MethodsA national survey of practicing pharmacists knowledgeable about OTC medication use by older adults asked participants to rank order the importance of the DFL sections to reduce ADRs in older adults. Open-ended questions focused on identifying ways of improving OTC medication labeling. Quantitative rankings were used to calculate the content validity ratio and analyzed using Wilcoxon signed rank tests. Qualitative results were categorized into themes.ResultsA total of 318 responses (12% response rate) were analyzed. There was high consensus that uses and purpose, active ingredient, warnings, and directions for use were the most important sections of the DFL. Within the warning section, 2 specific warnings, “Do not use” and “Ask a doctor or pharmacist,” were deemed most important. Similarly, qualitative themes focused on seeking health care provider assistance or were specific to age-related precautions.ConclusionsPrioritizing warnings that highlight the importance of possible drug-drug and drug-disease precautions and the need to seek medical advice before taking OTC medications were deemed most critical. Moving this type of information to the front of the package may help reduce ADRs among older adults.     

Assessment of knowledge,attitude and practice among community pharmacists towards dental care: A national cross sectional survey

BackgroundCommunity pharmacists’ contribution in health maintenance and promotion is significant but more studies are still needed to evaluate their role as healthcare providers.ObjectivesOur primary objective was to assess knowledge, attitude, and practice among community pharmacists in Lebanon towards dental care. Secondary objectives included assessing the barriers to a good dental care practice and assess their educational needs for oral health counseling.MethodsA national cross-sectional study was carried out using an online questionnaire and targeting community pharmacists in Lebanon. Five, three and six questions were used to assess pharmacists’ perceived knowledge, attitude and practice respectively. Stepwise linear regressions were conducted taking each time a different scale score as the dependent variable.Results497 (78.88%) pharmacists completed the survey (62% females). More than half (53.3%) exhibited good perceived knowledge, 39% a positive attitude and 47.3% a good practice regarding oral health. Pharmacists reported a good perceived knowledge regarding common oral conditions (good, very good and excellent knowledge: 73.2%). Most of the pharmacists (86.52%) perceived oral health promotion as an important part of their services. Moreover, 28.77% (n = 143) of pharmacists declared having difficulties in obtaining oral health information. The main barriers to a good practice included limited interaction between dentists and pharmacists and lack of training regarding oral health. The multivariable analyses showed a significant positive intercorrelation between perceived knowledge, attitude and practice. Working in the pharmacy for more than 40 h a week was associated with higher perceived knowledge (Beta = 2.846). Having a PhD degree was associated with lower practice scores (Beta = 3.676), whereas female gender was associated with lower practice scores (Beta = 2.334).ConclusionsPharmacists have the overall required knowledge and attitude to play an important role in the patients’ counseling towards dental care.     

A postal survey to assess the views of community pharmacists on the deregulation of emergency hormonal contraception

□ This was a postal survey undertaken before EHC was available nationally in UK community pharmacies □ The survey aimed to assess attitudes of UK community pharmacists towards the deregulation of EHC □ A response rate of 66 per cent was attained and the consensus was that community pharmacists broadly agreed with the deregulation of EHC □ Pharmacists believed that the supply of EHC through pharmacies would increase their professional status, and there would be need for GP collaboration □ Although pharmacists welcomed EHC deregulation, they had reservations about legal implications     

Ready,willing, and able to provide MTM services?: A survey of community pharmacists in the USA

BackgroundChanges in US Medicare legislation could benefit pharmacy's attempt to make medication therapy management (MTM) practice more commonplace; however, little is known about pharmacists' capabilities and preferences to do so.ObjectivesThe purpose of this study was to explore US pharmacists' perceived preparedness, willingness, and challenges toward providing MTM services.MethodsA brief purpose of the survey and its website link were included in the electronic weekly newsletter of the National Community Pharmacists Association (NCPA) in January 2007. The web-based survey consisted of 8 demographic questions, 8 questions examining preparedness and willingness of the respondents regarding MTM, 2 questions regarding reimbursement to pharmacists, and 2 checklists for challenges in establishing MTM services.ResultsMost of the 143 respondents indicated that they were aware of MTM, and 92 (65%) reported that they were currently practicing MTM. A majority of the sample agreed that pharmacists should provide MTM and have the ability to do so. Major challenges reported by the sample include the different specification of MTM by each health plan, time, staffing, and reimbursement issues. Respondents selected valid measures of program effectiveness but revealed that they needed help with documentation and billing. Expected reimbursement range was $1-10/minute.ConclusionCommunity independent pharmacists reported being ready, willing, and able to provide MTM services, but need assistance in the process, that is, standardized MTM protocols, documentation and billing.     

Using actor-partner interdependence modeling to understand recent illicit opioid use and injection drug use among men in community supervision and their female partners in New York City

BackgroundThe United States’ opioid crisis disproportionately affects individuals in the criminal justice system. Intimate partners can be a source of social support that helps reduce substance use, or they can serve as a driver of continued or increased substance use. Better understanding of the association between intimate partner characteristics and illicit opioid use and injection drug use among individuals in community supervision could be vital to developing targeted interventions.MethodsUsing actor-partner interdependence models, we examined individual and partner characteristics associated with recent illicit opioid use and injection drug use among males in community supervision settings in New York City (n = 229) and their female partners (n = 229).ResultsHigher levels of depression (aOR 1.98, 95% CI [1.39–2.82], p ≤ 0.01) and anxiety (aOR 1.98, 95% CI [1.42–2.75], p ≤ 0.01) were associated with recent opioid use among males in community supervision. Females with a partner having higher levels of anxiety were more likely to have recently used opioids (aOR 1.52, 95% CI [1.06–2.16], p ≤ 0.05). Males with a female partner with higher levels of anxiety (aOR 2.16, 95% CI [1.31–3.56], p ≤ 0.01) or depression (aOR 1.70, 95% CI [1.01–2.86], p ≤ 0.05) were more likely to recently inject drugs. Women with a male partner who had been in prison were more likely to have recently injected drugs (aOR 3.71, 95% CI [1.14–12.12], p ≤ 0.05), but women who had a male partner who had been arrested in the past three months were less likely to have recently injected (aOR 0.08, 95% CI [0.02–0.46], p ≤ 0.01).ConclusionsResults suggest that recent individual illicit opioid use and injection drug use is associated not only with individual-level factors, but also with partner factors, highlighting the need for couple-based approaches to address the opioid epidemic.